Get Well Soon

​Two weeks ago, another major shot was fired in the war between those who believe that decreasing carbohydrates are essential to weight loss, and those who believe low carb is no better than any other method of weight loss.

The study, by all accounts, was impressively executed (at the cost of $12M), and was designed to determine whether low carbohydrate diets had any advantage in terms of total energy expenditure as compared with medium and high carbohydrate diets. Simply said - is there a metabolic advantage, where your basal metabolism burns more energy per total calories consumed on one diet vs the other.

Advocates of the low carb approach to weight loss and weight maintenance subscribe to a physiological theory known as the carbohydrate-insulin model of obesity, where increased the increased ratio of insulin to glucagon after high glycemic meals directs fuels into storage in adipose tissue. The rapid storage of fuels as fat leads to increased hunger and food cravings, and decreased energy expenditures, predisposing to weight gain. In this model the degree of weight gain should correspond to the insulin level - as higher insulin levels lead to greater fuel storage. The theory provides an explanation for the global obesity trend as people have increased their consumption of high glycemic refined carbohydrates over the past 30 years.

The theory has some eloquent supporters, most notably journalist Gary Taubes, who founded the Nutritional Science Initiative (NuSi) to do the science necessary to prove or disprove the theory.

Until now, existing data has not provided support for this theory, with perhaps the greatest challenge coming from a NuSi study led by Kevin Hall, which was done under the controlled settings of a metabolic chamber.

Despite the lack of evidence from controlled feeding studies, supporters of the carbohydrate:insulin theory have maintained that studies were not long enough - most were only two weeks, and the process of adaptation to a low carb diet takes at least 2-3 weeks - or they were technically flawed (or both).

On the other side of the debate, many researchers and nutritionists point to the many real-world studies that have failed to show that low carb has any benefit over any other approach (ie. Mediterranean diet, Zone, low fat, etc.).

Since the study was about weight maintenance, all subjects (164 adults aged 18-65 years with a BMI >25) were put on the same weight loss diet with the goal of 12% weight loss (within 2%). After the run-in weight loss, the subjects were randomized to to three test diets according to carbohydrate content (high, 60%; moderate, 40% or low 20%). Each test diet was controlled to deliver the same amount of protein (20%) and were adjusted to maintain weight loss.

The results were supportive of the carbohydrate-insulin model:

those subjects on the low carb diet burned an extra 278 kcal/day compared to those on the high carb diet

if the subject had higher levels of insulin, a measure of insulin resistance, the effect was more dramatic - those on the low carb diet burned an extra 478 kcal/day

While these results seem to confirm the carbohydrate:insulin hypothesis, other researchers are not yet ready to concede. Kevin Hall, the researcher that led the original metabolic chamber, NuSi trial that failed to demonstrate any metabolic advantage to a low carb diet, and a known skeptic of the carbohydrate:insulin theory, has pointed out a potential methodological issue with the trials. He points out that the method that the researchers used to measure energy expenditure is less reliable when weight is changing - so the proper comparison for diet effect should be the difference between energy expenditure at the beginning of the trial, before any weight loss, compared to the weight at the end of the trial. Instead, the study compared the effects after the weight loss, and before randomization into the three experimental groups. If you look at the data from Hall's viewpoint, the metabolic advantage shrinks to less than 100 calories - an effect that may not be statistically significant.

Others point out that in the real world low carb diets do not outperform other diets when it comes to weight maintenance, and that this trial screened over

Still these findings are intriguing as they provide some evidence for the claim made by low carb proponents that low carb is easier than any other diet.

Healthline has an excellent review of 23 randomized controlled studies that shows an edge towards low carb, but many studies are very hard to assess because of variability in nutrient quality - DIETFITS was perhaps the best designed study to compare healthy low fat with healthy low carb - it essentially found no difference between groups.

with low carb diets - the focus is no restricting carbohydrate intake - with low fat the focus is to restrict total caloric intake and fat intake. Both approaches have similar compliance rates.

Observational studies show a potential increase in all-cause mortality with low carb diets but controlled trials show no adverse effects up to 2 years and no adverse effects from a biomarker perspective with the exception of increased LDL-C, which is offset by an decrease in LDL-P.

As with any diet - most of the benefit is in stopping the consumption of added sugars, refined carbohydrates and junk food,

Solely focusing on macronutrients can be potentially harmful if it ignores food quality - neither pepperoni nor pepsi are healthy even though one could say they fit into a LCHF and a LFHC diet respectively.

While there are debates about LCHF and LFHC - there should be no debate that a HFHC is the real issue in our society today. Too many people are eating too many calories from poor quality sources high in both fat and carbohydrates. This simply put is the cause of obesity in our society.

Try as we might to learn more about nutrition, nothing beats the the simple rules laid out by Michael Pollan, in his book "In Defense of Food":

Eat Real Food

Not too much

Mostly plants

#takecontrolofyourhealth

At Wellness Garage - we can help you understand, and take control of your health. Our comprehensive medical, fitness, nutritional and behavioral assessments give you baseline from which to measure your progress. Our coaching helps you improve your behaviors, one habit at a time.

With the end of daylight savings, once again we are reminded that we are beginning the dark days of winter when we no longer can rely on the sun to get our Vitamin D.

Vitamin D is essential for human health. Best known for its role in calcium metabolism and bone health, Vitamin D deficiency has been implicated in over 100 different disorders ranging from heart disease, hypertension, both Type I and Type II diabetes, depression, cancer, auto-immune disease, and multiple sclerosis. Vitamin D receptors are found in almost every type of human tissue.

During the summer, we are able to synthesize Vitamin D through the stimulus of mid-day sunlight on our skin. Specifically, the UVB rays in sunlight catalyze the conversion of 7-dehydrocholesterol into cholecalciferol - Vitamin D3. Vitamin D3 travels through the blood, via Vitamin D binding protein to the liver where it is converted to 25(OH) D which then circulates to the kidney and other tissues to be converted into the active form of Vitamin: 1,25(OH) D.

At our northern latitude, UVB strength is not sufficient from October to March for us to generate Vitamin D, so we need to get our "D" from our diet. Unfortunately, very few foods contain significant amounts of vitamin D (fish, shiitake mushrooms being exceptions). To address this, most dairy products have been fortified with Vitamin D. Despite this, most Canadians get insufficient Vitamin D levels for optimal health.

At Wellness Garage - we recommend that everyone supplement with Vitamin D from October to March. Until recently, our recommendation was to take 2000 IU of high quality Vitamin D daily.

We now have a better way for our members to get their Vitamin D: the Solius light booth.

Solius was designed to deliver the specific frequency of UVB light that stimulates Vitamin D production in the skin without the risk of sunburn. By targeting and isolating specific UVB frequencies, only 0.15% of the sun's spectrum, Solius maximizes the efficacy of Vitamin D synthesis with extremely low ultraviolet exposure. Put in perspective, one 3 to 4 minute Solius treatment, on average, provides the same amount of UV radiation as 9 seconds of midday summer sunlight, yet synthesizes enough Vitamin D for a week!

The greatest risk from UV radiation comes from UVA exposure - in fact tanning beds deliver greater than 95% UVA and greatly increase the risks of developing skin cancers. UVB light sources minimize UVA and have not been associated with increased cancer risk. Compared to other UVB sources, Solius further reduces exposure to overall UV radiation through its patented delivery system.

Solius is the safest way to produce Vitamin D naturally.

One Solius treatment weekly is all that is needed to optimize your Vitamin D. There is no risk of over or under treatment with Solius, since light is the natural input for Vitamin D production. Just as there is no danger of excess Vitamin D from a day in the sun, Solius, by leveraging the body's natural feedback mechanisms avoids the risk of super physiological doses. Vitamin D3 produced in the skin delivers a slow and steady dose of pro-hormone to the liver that is distinctly different from the absorption of supplements from the intestine.

While Solius prevents "over-dosing" of Vitamin D, under-dosing is the more prevalent issue for most people supplementing. At the recommended daily dose of 600 IU (800 IU for age > 70) many people do not reach adequate Vitamin D levels. Since Solius triggers the body's natural response and feedback system - optimal physiologic levels are achieved.(for more on the variation of Vitamin D levels - see our previous post on Vitamin D).

Wellness Garage is fortunate to have one of only two Solius booth's deployed (there will be many more to come). To experience Solius - download the Solius app from the Apple or Google Stores), register and book through the app.

For those of you that do not have a Solius near by and still need to supplement, here are our recommendations:

At Wellness Garage - we can help you understand and take control of your health. Our comprehensive medical, fitness, nutritional and behavioral assessments give you baseline from which to measure your progress. Our coaching helps you improve your behaviors, one habit at a time.